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PTU-180 Bile Acid Diarrhoea – the Good, the Bad and Equivocal Responders: a two Centre Comparison
  1. A Dhaliwal1,
  2. S Chambers1,
  3. C Nwokolo1,
  4. N Williams2,
  5. J Cullis2,
  6. P Basumani3,
  7. M Smith4,
  8. K D Bardhan3,
  9. R Arasaradnam1
  1. 1Gastroenterology
  2. 2Radiology, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry
  3. 3Gastroenterology
  4. 4Radiology, Rotherham General Hospital NHS Trust, Rotherham, UK

Abstract

Introduction Bile acid diarrhoea (BAD) is a common cause of chronic diarrhoea, currently diagnosed using Se75-homo-chloro-tauric-acid (Se75HCAT) testing, the “gold standard” in the UK and available to centres which support a gamma camera. Although the test has been available for over two decades, uptake has been slow despite its diagnostic value and evidence that treatment with sequestrants can be effective. This stems from a lack of formal clinical trials, which encourages a belief the good results reported may reflect patient selection, resulting in therapeutic nihilism. Thus the aim of this study was to compare treatment results between two centres: experienced (α), using data reported earlier, and novice (β), with current data.

Methods The patients recruited comprised those with structural disease (e.g. ileal resection, cholecystectomy), and non-structural, the majority with diarrhoea-predominant irritable bowel syndrome (D-IBS). Abnormal Se75HCAT results were defined as < 10% retention on Day-7. Response to treatment: 1st line (cholestyramine, colestid, colesitpol) or 2nd line (colesevelam) was recorded in three categories: good, partial or poor.

Results Centre α: 2001–2006; recruited n = 162; treatment assessed n = 129.

Centre β: 2008–2012; recruited n = 126; treatment assessed n = 99.

Response to treatment

Abstract PTU-180 Table

D-IBS – Abnormal Se75HCAT: centre α 33%, Centre β 31%.

Disclosure of Interest None Declared.

Conclusion

  1. Both centres had similar proportions with abnormal Se75HCAT values, suggesting gastroenterologists are able to select appropriate patients who are likely to benefit from the test.

  2. Treatment response in both centres was similar, ~70% responding. This suggests treatment is genuinely effective and not limited only to centres with a special interest.

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